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Tuesday, October 28, 2014

Ebola Today 10/28


A Good News Day
OK, today we should lead with the best news. According to the The Washington Post, upon nurse Amber Vinson's recovery, and release from the hospital, there is only ONE patient left in the United States being treated for Ebola. That is to say, only one person of the 316 million people in the United States, has Ebola, at this time. Everyone else, except poor Thomas Eric Duncan, has recovered, and has been released.

More good news today
Although there is still a great need for international assistance, according to The New York Times, the spread of Ebola is slowing in Liberia. Health authorities in the region have come to that conclusion from the following facts:
  • Liberia's health authorities are reporting lower numbers of new infections.
  • Treatment centers in Liberia's capitol city of Monrovia, who were turning away victims for lack of space, are now reporting some unoccupied beds.
  • The number of burials of victims has started to drop.
"Do we feel confident that the response is now getting an upper hand on the virus? Yes, in Liberia we are seeing a slowing rate of new cases, very definitely." ~~ Dr. Aylward, World Health Organization's Assistant Director-General in charge of WHO's operational response to the epidemic.
Bear in mind, nearly half of the total number of people infected have been infected in Liberia. Also note, about 5,000 of the almost 14,000 people infected, are reported to have died of the disease, and according to Dr. Aylward, in the three countries most affected, Guinea, Liberia, and Sierra Leone, there is still a 70% mortality rate. In the United States, of those who developed the virus while in the United States, our mortality rate is more like 20%. Of course, it looks like we know how to handle it better than we did when Thomas Eric Duncan showed up in Texas. And all of the cases after him in the United States have recovered. Just waiting for Dr. Craig Spencer to join that group. (There is some low level noise out there about Dr. Spencer lying about his whereabouts upon returning to the United States, but there are no accurate sources to back that one up. And no one else in New York has reported symptoms, including his girlfriend.)

That being said, there is still alot of scarem juice going around. If you pay attention to social media, the policy being suggested by the none scientific general public is to get your pitchforks, and guns, and take your country back from the Ebola Dictator Obama. It's Obama derangement syndrome on steroids. In the real world, however, Governor after Governor actually have to decide what is the best way to ensure the health and safety of their residents.

Under CDC guidelines that went into effect Monday, individuals at any risk of exposure to the virus should be actively monitored until 21 days after the last potential exposure, even if they show no symptoms of the disease. The guidelines are not mandatory.

Who's Being Monitored Now?
MICHIGAN ~~ Health officials are now monitoring ten people in Michigan for the Ebola virus, the Detroit Free Press reports. According to the health department spokesman, none of these people are believed to have had direct contact with anyone who has Ebola, and the Michigan Department of Community Health confirms none of the people being monitored have shown symptoms of the deadly disease. Nonetheless, the cases involve individuals who were in countries with widespread Ebola transmission within the last 21 days. MDCH is not releasing their identities or where they live out of respect for their privacy.

INDIANA ~~ Indiana was one of the first states to begin “direct active monitoring” of returning travelers. Gov. Mike Pence and the Indiana State Department of Health implemented the policy on Oct. 16. The local FOX affiliate in Indianapolis WXIN reports that state health officials are monitoring six people in Indiana for Ebola symptoms in accordance with guidelines from the Centers for Disease Control and Prevention. Two patients have completed the monitoring protocol while six others are currently under observation. They’re cooperating with the protocol, which lasts 21 days. State health officials aren’t releasing the names of the counties where travelers are being monitored in accordance with privacy laws.

All are considered low risk.

What Is Monitoring?
Monitoring includes twice-daily temperature and symptom checks by local health agencies. That's it. Hit a temperature of 100.4, you get packaged up, taken into a hospital for treatment, and, of course, quarantined. Until then, you just have to take your temperature.

The CDC’s new travel guidelines group people into four categories based on exposure to Ebola: high risk; some risk; low, but not zero risk; and no known risk.

  • People in the high risk category, such as a healthcare worker who treated an Ebola patient, should be monitored by a health official and avoid commercial travel and large gatherings.
  • Those with some risk should be monitored by a doctor, and would be allowed to travel on a case-by-case basis.
  • Travelers with low, but not zero, risk should watch for symptoms.
  • Those with no known risk don’t have to monitor their health. Duh.

Schools And Parents Overreacting?
Maureen Downey of the The Atlanta Journal-Constitution took a stab at the issue. Parents with school aged children are getting concerned, and most local mayors and school boards aren't doing much to help assuage that fear.

We may see the issue of kids being barred from attending school addressed in Connecticut sooner than in other states. A lawsuit has been filed in the state after a school district refused to allow a third-grader to return to school after she attended a wedding in Nigeria, a country declared Ebola-free by the World Health Organization. Her father is suing the Milford district for banning the child from school, noting the family was never quarantined by the city after returning from Africa, the school system felt safe enough to send a tutor to the house, a doctor who examined the girl proclaimed her healthy, and she had no contact with, nor was anywhere near, any Ebola patients while in Nigeria. The family attorney suggested the ban had more to do with public concerns than real health concerns.

Civil Rights Versus Public Safety
“Normally one can’t be locked up without suspicion of a crime or conviction, but because we are dealing with infections, and because they can be spread by people who are not visibly sick, the state has the right to protect society from disastrous consequences by temporarily limiting someone’s liberties,” said Eugene Kontorovich, a constitutional law scholar at Northwestern University Law School in Chicago.

Of course, given all the available evidence, Ebola patients would definitely be visibly sick when they were infectious. They would be vomiting, and liquid would be coming from every part of them. It causes bleeding inside and outside the body.

Hickox is on the front lines of this dispute. Now that she is back home in Maine, and still asymptomatic, and still virus free according to repeated tests, Maine officials are seeking a court order to force her to self-quarantine at home. Acccording to NBC News, Hickox emerged from her home today, Wednesday, to tell reporters that she and her attorneys had been in negotiations all day with state officials, but that the impasse remained.

"They will not allow me to leave my house, and have any interaction with the public, even though I am completely healthy and symptom-free," Hickox said as her boyfriend stood beside her — and as a state trooper, who has her under surveillance, looked on.

We've been here before. Health officials in the U.S. have a long history of taking steps in the interest of public health, including closing schools and ordering large-scale quarantines, such as the one imposed during the 1918 influenza epidemic that was credited with limiting the spread of the disease. Of course, in 1918, we weren't able to treat, and cure, patients with plasma infusions.

Some public health experts say aggressive, widespread quarantines may be illegal, are not based on medical evidence, and can be counterproductive. Health officials have a certain ethic to uphold, but ordinary citizens might hide their potential exposure, or recent travel history, as a result. Most importantly, as we have mentioned in previous articles, this kind of government reaction, in the current environment, could also dissuade health care workers from volunteering to fight Ebola in West Africa, where the epidemic is just starting to get under control due to the caring and fearless work of those very same healthcare workers.

Unnecessary quarantines create unnecessary fear.

Feeling Helpless?
Well, there is only so much each of us, individually, can do to help out here. Unless you are a health hero putting yourself on the line helping patients in the United States heal, or jetting overseas to help on the front lines, what can you do?

Without saying any charity is helping more than any other, we offer one option of a place to donate. Unicef USA.

Stay with us daily as we report what we find, and vet what we can.

The Policy Geek

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